CyberKnife Radiotherapy with Robotic Radiosurgery

Millimetric Accuracy Radiosurgery

CYBERKNIFE

It is used in the treatment of tumors requiring a complex operation, non-operable tumors or tumors which could not be treated via classic radiotherapy.

What is CyberKnife?

CyberKnife is the robotic radiosurgery system designed to treat cancer anywhere in the body. With the help of this system, radiation beam is used focally and cancerous tissues in the brain and the body could be treated with high dosages. Normal tissues could be protected to a higher extent from the effects of the radiation. With the robotic technology controlled by computers, this treatment device rotates around the patient, almost like dancing, and carries out the treatment by providing irradiating from hundreds of different angles. CyberKnife device consists of lots of sub systems which have lots of advanced technology such as; the system which tracks the location of the tumor with the guidance of imaging and the computer controlled highly accurate robot and modern robotic patient positioning system... All these systems facilitate the treatment of the tumors with high accuracy.

Basically CyberKnife is an advanced linear accelerator which is placed on a robot used in industry. It is a Stereotactic Radiosurgery (SRC) (high dosage focal radiation treatment) device which uses the radiation beams focally and treats cancerous areas in brain, body and especially hard to reach areas, with high dose of radiation while allowing maximum protection of the normal tissues. Stereotactic Radiosurgery (SRC) which means treatment of a target with the help of the coordinates consists of destroying the tumor completely in one treatment séance with the high dose of radiation following the determination of the coordinates with a three dimensional method. When this treatment is applied in more than one treatment séance, usually in 3-5 treatment séance, it is called Stereotactic Radiotherapy (SRT).

Which cancers can it treat?

CyberKnife is used for both cancerous and non-cancerous tumors anywhere in the body and brain. It is applied as Stereotactic Radiosurgery and Radiotherapy. The reason “Radiosurgery” term is used is that this method has now replaced most surgeries performed in the past.

In brain tumors: Cyberknife is used in all the lesions of brain and head-neck area without there being any limitation on the size and location. As well as single treatment séances with high dosages which are called Radiosurgery, it is also used in the application requiring more than one séance as Stereotactic Radiotherapy in the tumors which are adjacent or close to the vital organs which are possible to be damaged. CyberKnife is a device used in the treatment of both cancerous and non-cancerous tumors, metastases, arteriovenous malformations and some functional diseases.

It is applied in lung cancers, prostate cancers, head-neck cancers, vertebrae tumors, pancreas cancers and metastases which cannot be treated by other methods and which are low in number, in lung or liver tumors in which the tumor is displaced via respiration or bowel movements.

In some tumors for which the treatment was not possible in the past or the treatment was only possible via crippling surgery: For these kinds of tumors, CyberKnife Radiotherapy System is applied safely without harming the patient. For example in the patients who have tumors in their eye area and carrying the risk of losing the eye and the diseases of spine which are oversensitive to radiation.

In the recurring tumors on the irradiated areas: CyberKnife is applied to the patients who received radiotherapy before but whose disease is recurring in the same location. A second application can be made in these kinds of tumors.

What are the features of Cyberknife treatment?

Cyberknife is a radiosurgery method which requires a complex operation and used in the treatment of multiple and inoperable tumors. With CyberKnife, which is a SRC/SRT method, inoperable, small and hard to reach lesions can be treated in millimetric accuracy.

CyberKnife is a method used as an alternative to the surgery. It does not require surgery. It provides a choice to the patients for the treatment of inoperable tumors or tumors requiring a complex operation.

It could minimize the damage to the healthy tissue around the tumor by treating with accuracy under millimeters.

CyberKnife treatment is applied in a single séance or up to 5 treatment séances based on the patient. Tumor and patient movement is followed up at the same time with the help of computer controlled robot technology and image guidance system. Thus momentary changes during the treatment could be determined and corrected.

It makes the necessary corrections by following up the respiration and tumor movements related to respiration in an accurate way and carries out the radiation on accordance with it. It can carry out simultaneous treatment to multiple tumors. The treatment is painless. Thus, no anesthesia is needed for the treatment and patients do not feel pain or aches during the treatment.

Water soluble plastic masks and special beds which do not cause any physical strain for keeping the patient restrained especially in the head and body areas during the application. For CyberKnife treatment patients do not need to be an inpatient. Patients are usually go back to their normal lives and return to their jobs right after the treatment.

The treatment planning is carried out by an interdisciplinary team work.

How does CyberKnife System Work?

CyberKnife Radiosurgery System basically consists of a robotic patient bed which could move towards 6 directions, a linear accelerator which produce 6 MV x-ray and weighs 140kg and placed on a 6-jointed industrial robot. CyberKnife, enables the irradiation of the tumors by bringing together computer controlled robot system with determining the location of the target with imaging, different than the classic SRC methods with 0,2 mm robot accuracy.

How is the treatment applied?

CyberKnife is applied to the patient by placing a plastic mask over the face of the patient without any surgical operation. During the treatment, the patient lies on a table which is controlled by a robot and which could move in 6 dimensions. An image capture system, which determines the location of the tumor and which follows up the tumor movements and change the position of the patient when necessary, is used. With the help of this system tumors in lungs and liver which changes their location due to the respiration could be treated by SRC/SRT. During this treatment the patients are not required to hold their breath or breathe in a steady way. The system compares the Computer Tomography and Magnetic Resonance images which are taken before the treatment with the real time images taken during the treatment. Tumor coordinates gained from this are evaluated with the help of computers in real time and then the dose of the radiation is set. Thus the treatment is not affected by the little movements of the patient. The treatment is limited to the tumor and the damage to the healthy tissue could be minimized. CyberKnife System which uses a computer controlled robot technology, the treatment device rotates around the patient and carried out the treatment from hundreds of different angles. The accuracy rate is up to 0.95mm in the irradiation of the targets.

The System which could carry out robotic radiosurgery in all the areas of the body

Real time imaging during the treatment

Automatic patient position correction during the treatment

Accurate and continuous treatment against the relocation of the tumor due to respiration movements of the patient

Treatment without surgical operation in single and multiple séances

Technical Specifications of CyberKnife

6 jointed robot with the ability to rotate

40kg linear accelerator placed on the robot which could produce 6 MV x-ray

12 different collimators with diameters in 5mm up to 60mm

IRIS collimator (a collimator which adjusts the diameters of all collimators automatically)

Automatic collimator changer

CyberKnife System weight (robot and LINAC): 1586 kg

Robotic treatment bed which could rotate in 6 directions

Weight of the treatment bed: 453 kg

Total clinic accuracy is less than 1mm

Ability to irradiate from 1200 different points

Opportunity of planning for physicians from home or from office

Which specialists apply CyberKnife Treatment?

In the cancer treatment with CyberKnife which is applied in Acıbadem Hospitals Group, the treatment team consists of the specialists below: Radiation oncology specialists, medical physics specialists responsible from the quality of the applied treatment, radiotherapy technicians who use the treatment devices, doctors, nurses and secretariat and support teams which provide services in all kinds of transactions and questions.

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